Greg Kuzma was acting as a chief financial officer for a northern Arizona hospital when, in 2011, he reportedly informed the CEO of Yavapia Regional Medical Center – a different hospital from the one that Kuzma worked at – that he had noticed that Yavapai had been reporting inflated hourly costs of workers to the government in seeking Medicare reimbursements. Kuzma was given the reply that the hospital would look into the matter. A year later, Kuzma informed another executive at Yavapai about the inflated numbers during a ski trip, and was given the same non-committal response. Following these two interactions, Kuzma later filed a False Claims Act (FCA) suit against the hospital. The US Attorney’s Office in Arizona later decided to join in the suit, resulting in a $5.9 million settlement agreement with the hospital, with $1.17 million of the recovery to go towards Kuzma for his participation in bringing the whistleblower suit.
The Nature of Yavapia’s Medicare Fraud
In its October 2016 announcement of the settlement agreement, the US Attorney’s Office described how the hospital fraudulently inflated the hours worked by its employees for the years 2006 to 2009, which resulted in the hospital being able to receive artificially inflated Medicare reimbursements for those years. Although the hospital later readjusted its reports to the federal government to reflect the accurate number of hours worked for the years going forward, this readjustment was used as evidence to show that the hospital knew what it was doing in having previously reported inflated hours, and yet did not rectify the earlier fraud. According to court documents, the hospital was able to recover $15 million in Medicare payments it should not have received.
Bringing an FCA Claim for Medicare Fraud
Medicare and Medicaid fraud costs the federal government nearly $100 billion a year, which is about $300 per person in the US, with that money coming out of the pockets of taxpayers like you and going into the bank accounts of greedy health care organizations. But there is a way for individuals to fight back against this widespread fraud while being rewarded for their courageous efforts. Individuals who have knowledge of Medicare fraud can work with an experienced, whistleblower attorney to report Medicare fraud through an FCA claim, and they may be able to recover up to 30% of the amount recovered by the federal government through a whistleblower reward.
Work with an Experienced Whistleblower Attorney
Kuzma’s story demonstrates the great personal rewards that a citizen can obtain for doing the right thing in bringing evidence of illegal Medicare fraud to the attention of federal authorities. Kreindler & Associates is dedicated exclusively to protecting and helping whistleblowers who make the courageous decision to expose fraud, just as Kuzma did. If you are considering making a whistleblower claim or feel that you’ve been the victim of wrongful retaliation for having done so, contact us today. We’re here to answer all of your questions and guide you through the whistleblowing process.
